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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003801
Report Date: 11/15/2024
Date Signed: 11/15/2024 10:54:43 AM

Document Has Been Signed on 11/15/2024 10:54 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:LIFESTREAM HOME CARE IIFACILITY NUMBER:
306003801
ADMINISTRATOR/
DIRECTOR:		TOLENTINO, FLORENCEFACILITY TYPE:
740
ADDRESS:8361 SUNNYBROOK CIRCLETELEPHONE:
(714) 228-0022
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY: 6CENSUS: 5DATE:
11/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Florence Tolentino - AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:07 AM
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On 11/15/2024 LPAs Dwayne Mason Jr. and Nancy Guillen arrived at the facility for the purpose of conducting a Case Management visit in order to conduct a Health and Safety Check and provide guidance on Title 22 Regulations. LPAs met with Florence Tolentino, Administrator and explained the purpose of the visit.

LPAs conducted a Health and Safety Check at the facility. LPAs observed residents lounging in the living room and listening to live music provided by a hired guitarist.

The facility appears clean safe and sanitary. No hazards to resident safety were observed.

LPAs also provided Administrator with guidance on questions they had regarding administering hospice medication and prohibited health conditions.

No deficiencies were issued as part of this inspection. LPAs reviewed the report with facility staff and provided a copy.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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